To evaluate rotational stability of Toric Implantable Collamer Lens (ICL) implantation to correct myopic astigmatism.

We estimated the degree of Toric ICL rotation together with change in visual acuity and astigmatism in 118 eyes of 66 patients who underwent Toric ICL implantation and had a long-term mean follow-up period of 37 months.

After Toric ICL implantation, 107 (91%) out of 118 eyes showed uncorrected visual acuity of 0.8 or better. The mean postoperative astigmatism decreased to -0.64 ± 0.61 D from a mean preoperative astigmatism of -2.96 ± 1.13 D. The mean axis change of Toric ICL was 2.4 ± 3.8 degrees during follow-up period. Two (1.7%) out of 118 eyes showed the axis change of more than 10 degrees. These two eyes had a decrease in visual acuity, rotational axis change of 18 degrees and 30 degrees, respectively, and increases in astigmatism of 1.50 D and 1.00 D, respectively. The remaining 116 eyes (98.3%) showed excellent rotational stability without visual acuity decreasing Toric ICL rotation during the follow-up period.

Toric ICL implantation to correct high myopia with astigmatism rarely has axis rotation and maintains excellent rotational stability for long-term follow-up.